Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Obesity (Silver Spring). 2021 Oct;29(10):1719-1730. doi: 10.1002/oby.23245. Epub 2021 Aug 6.
This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID-19.
The primary outcome was in-hospital mortality in adults with COVID-19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI-RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable-adjusted models were used.
Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m was associated with a greater risk of ARDS and AKI-RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers.
In critically ill patients with COVID-19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI-RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID-19 by upregulating systemic inflammatory and prothrombotic pathways.
本研究旨在确定肥胖是否与 COVID-19 重症患者的主要不良临床结局以及炎症和血栓形成标志物独立相关。
主要结局为美国重症监护病房收治的 COVID-19 成年患者的院内死亡率。次要结局为急性呼吸窘迫综合征（ARDS）、需要肾脏替代治疗的急性肾损伤（AKI-RRT）、血栓事件以及炎症和血栓形成的 7 个血液标志物。使用未经调整和多变量调整模型。
在 4908 名研究患者中，平均（SD）年龄为 60.9（14.7）岁，3095 名（62.8%）为男性，2552 名（52.0%）患有肥胖症。在多变量模型中，BMI 与死亡率无关。BMI 从 25kg/m 开始升高与 ARDS 和 AKI-RRT 的风险增加相关，但与血栓形成无关。BMI 与炎症或血栓形成标志物之间没有临床显著关联。
在 COVID-19 重症患者中，较高的 BMI 与死亡或血栓事件无关，但与 ARDS 和 AKI-RRT 的风险增加相关。BMI 与循环生物标志物之间缺乏关联，这使人们对肥胖通过上调全身炎症和促血栓形成途径导致 COVID-19 重症患者预后不良的观点产生了质疑。
